Nursing Care in Radiotherapy

8/13/2019 Nursing Care in Radiotherapy

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Nursing Management forPatients Receiving Radiotherapy

Chanphen Manosilapakorn, RN, PhD


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Nursing Goals

The nursing care for patients being treated with

radiation must be aimed not only at problemsassociated with the disease and its effects onthe way the individual functions,

but also at minimizing, controlling andpreventing the effects associated withradiotherapy.


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Nursing Care Must be...

Individualized & Holistic

Intelligent & Thoughtful Scientific & Compassionate

Quality of Care


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Effective Care

Effective care, incorporating information and

counseling, cannot be given, unless the nurseis aware of the biological effects of radiationand how these may compromise the patientsnormal activities of daily living.


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Questions for the 1st

Step!

What is the diagnosis?

What is the prognosis?

What is the goal oftreatment?

Does the person knowand understand thediagnosis?

How is about the family?

What is the plan oftreatment? Adjuvanttherapy?

What does the person

know and understandabout radiotherapy?

Where can the correctinformation about theindividuals treatmentplan be obtained?


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Who involve in radiation team? OncologistDiagnosis and treatments

NurseNursing care (pre-radiation,during radiation and post-radiation)

PhysicsCalculation on the amount ofdose in radiation

RadiologistProviding radiationregarding the physicians order


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Radiation Therapy Planning Therapy usually planned on a

simulator (x-ray unit) Patient needs to be positioned to

allow reproducibility and comfort

Oncologist choose target volume(tumor+margin)

Target volume uses the arrangementof beams (high dose in target andminimizing dose in normal tissue)


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Pre-Radiation Preparation of knowledge on radiotherapy

by assessing and giving information What is radiotherapy?

How much expenses for radiation?

Can the 30 scheme (national health insurance)cover the radiation?

How long for the radiation?

What will be complications? How to take care of yourself?


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Pre-Radiation Preparation of patient (body)

Laboratory testsCBC, Elyte, Bloodchemistry


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How to take care the treated area? Keep the skin dry

Do not remove the ink marks

Avoid using powder, lotions, creams,

alcohol, and deodorant Wear loose-fitting cloths

Shave with an electric razor only Protect the skin from direct sunlight,

chorine, and extreme temperature


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Side Effect of Radiation Acute side effect

Occur because of damage to stem cells inrapidly dividing mucosa, e.g., pharynx, smallbowel

Usually begin 7-10 days after the start, andsubside 2-3 weeks after treatment

Chronic side effect Occur because of damage to stem cells in slowly

dividing tissues

Often permanent, irreversible May need surgical correctionfistulas, strictures

Specific side effect


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Side-Effect of Radiotherapy Fatigue

Anorexia Mucositis

Xerostomia

Alopecia

Skin reaction

Nausea & Vomiting

Esophagitis &Dysphagia

Diarrhea

Cystitis

Bone marrow

depression


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Fatigue.. Factors contributing to fatigue

Surgery/Chemotherapy

Pain

Malnutrition

Medications

Anemia Normal lifestyle

Nursing Care

Assessing contributing factors, and encouragingpatient to rest and limit daily activities.


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Anorexia.. Factors contributing to anorexia

Waste products of tissue destruction, anemia, inactivity,medications, and psychological problems

Nursing Care

* Eat small, frequent meals* Change diet and environment

* Stimulate appetite

* Eat nutritious and high protein snacks* Avoid fatty or greasy foods

* Take nutritional supplements


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Mucositis/ Stomatitis.. Mucositis is.

A patchy, white membrane become confluent and maybleed if disturbed.

Nursing Care

* Avoid irritantsalcohol, tobacco, spicy, acid foods orhot drinks

* Eat soft or liquid diet

* Mouth care with saline or water frequently


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Xerostomia.. Xerostomia is associated with the dry mouth that

results from radiation to salivary glands

It includes alterations in taste

Nursing Care

* Moisten foods* Use artificial saliva* Make foods easier to eat* Avoid dry foods

* Soak foods in coffee, milk or warm drinks* Mouth care with saline frequently


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Alopecia.. Alopecia is descried as the loss of hair that can occur

with the radiation of the brain

Nursing Care

* Gently brush and comb, infrequently shampoo

* Avoid the use of hair coloring and chemical

* Give psychological support for change of body image

* Give advice for using wig if necessary


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Skin Reactions Skin reactions include erythema, dry and moist

desquamation

Nursing Care

* Prevent increasing irritation and avoid scratch* Not to use any perfumed soap, ointments or deodorant

* Use baby powder or maize starch

* Wear loose-cloths and cotton made rather syntheticmaterials

* Open to fresh air but not direct to sunlight

* Teach patients about skin careskin emulsion cream

for dry, and pain management and antibiotic spray formoist desquamation


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Nausea & Vomiting.. Xerostomia is associated with the dry mouth that

results from radiation to salivary glands

It includes alterations in taste

Nursing Care

* Eat small, frequent meals

* Eat salty foods, add salt in foods* Drink clear or cool beverages* Avoid overly sweet, greasy or high fat foods

* Rest with the head elevated after eating* Mouth care* Take antinausea or antiemetic medications if necessary


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Esophagitis & Dysphagia Firstly recognize difficulty in swallowing

solids and make swallowing painful resultingin decrease in intake foods and fluids

Nursing Care* Eat high-calorie, high-protein diet

* Drink plenty of liquids

* Eat soft and liquid foods* Blenderlize solid foods


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Diarrhea Can occur if the areas of the abdomen and pelvis are

treated

Nursing Care

* Drink plenty of fluids to avoid dehydration* Avoid milk or dairy products

* Avoid foods high in fiber

* Avoid high fat, spicy, and gas forming foods* Electrolyte replacement--potassium


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Cystitis Cystitis and urethritis result from radiation to

the pelvic and bladder areas

Nursing Care

* Urine examination* Drink plenty of fluid

* Observe infectious signsfever, difficulty of

voiding* Avoid moisture in the area treated

* Take antibiotic as prescribed


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Bone Marrow Suppression Can occur if the areas of the abdomen and pelvis are

treated

Nursing Care

* Examine blood counts weekly

* Observe signs and symptoms of bleeding, anemia,and infection

* Teach patients to look for these signs

* Transfuse blood components as necessary* Give health education on nutritious foodsegg


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Nurses Roles Provision of nursing care

Emotional support Monitoring/ Coordination

Health education Follow up/ Referral system

Promotion of quality of life


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Question

How you can give health

education to patient receiveradiotherapy?


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Thank you for your attention!!

Documents

Nursing Care in Radiotherapy